Increasing healthcare insurance costs have driven consumers to seek alternatives to traditional employer-sponsored healthcare benefit plans that provide full coverage for medical treatments and for prescription coverage. Consumers are opting for lower premiums and coverage that requires greater out-of-pocket payments than typical co-payments and deductibles. In addition, consumers are also increasingly using medical spending accounts with tax incentives to pay for healthcare related transactions. As a result, for each and every transaction, service providers (e.g., doctors) often need to make claims from multiple sources (e.g., the consumer, one or more benefit plans, benefit spending accounts, etc.).
FIGS. 1-3 illustrate various conventional healthcare insurance payment mechanisms. As can be appreciated, the variety of payment sources and cost sharing plans utilized by consumers can be complex and can result in increased transaction costs such as resource consumption, timeliness of payments, administration costs, collections, and the like.
With reference to the process flow diagram 100 of FIG. 1, a consumer 110 receives healthcare/treatment from a provider 120 and, at step 115, pays a member cost share for the treatment (e.g., a relatively small co-pay, co-insurance deductible, etc.). Thereafter, the provider 120, at step 125, files a claim with a health plan 130 that, at step 135, reimburses provider 120 the amount covered as provided by the terms and conditions of the plan. The provider 120 may then, at step 145, bill the consumer 110 for any remaining uncovered costs of the treatment.
In an alternative conventional arrangement, as illustrated in the process flow diagram 200 of FIG. 2, a consumer 210 may receive healthcare/treatment from a provider 220 and, at step 215, pay a portion (or all) of the costs of the treatment. The provider 220 may then, at step 225, file a claim with the health plan 230 for payment for the treatment, and the consumer 210 may, at step 235, separately file a claim with the health plan 230 for reimbursement of any payments.
With reference to the process flow diagram 300 of FIG. 3, another variation is provided in which consumer 310 receives healthcare/treatment from provider 320 and, at step 315, pays a significant portion (or all) of the cost of the treatment (co-pay, co-insurance, deductible, etc.) directly to the provider 320. The provider 320, at step 325, files a claim with a health plan 330 of the consumer 310 that may, in turn, at step 335, pay the provider 320 the full amount specified in the filed claim or a portion thereof. In addition, the consumer 310 may, at step 345, draw from funds from a financial institution 340 equal to all or a portion of the amount paid by the consumer 310 out-of-pocket for the treatment. The financial institution 340 may manage or operate tax-advantaged, health specific savings accounts (e.g., FSA—flexible spending accounts, HRA—health reimbursement accounts, HSA—health savings accounts, etc.) that may be used for qualified healthcare treatments/prescriptions.